Organization
PSYCHOLOGICAL HEALTH CARE OF NY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL E KISSIN PH.D. (OWNER)
(718) 332-6025
Entity
Organization
Contact information
Practice address
2797 OCEAN PKWY, BROOKLYN, NY 11235-7861
(718) 743-7700
Mailing address
65 ORIENTAL BLVD APT 12C, BROOKLYN, NY 11235-4913
(718) 332-6025
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
009369
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
009369
LICENCE#
NY
05
—
01499105
—
NY
01
—
2319570
UHC
NY
01
—
P2786335
OXFORD
NY
01
—
VWW351
BCBS
NY
Enumeration date
12/19/2006
Last updated
05/10/2008
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